One of the most costly and concerning healthcare expenditures is emergency room visits. Providers and payers are especially concerned with the uptick in ER visits, because ER visits are known to be extra costly and peppered with discressionary visits. Providers and payers have decided lowering ER useage could be done by identifying ER abusers and preventing people from getting sick. However, to do this having access to information is necessary. In a recent report in Healthcare Payer News UnitedHealthcare discussed how they have reduced hospital and ER usage, increased quality and decreased operating costs by sharing patient data through a healthcare information exchange (HIE).
HIEs are known to improve coordinated care and care management as well as minimize unnecessary costs by sharing patient information amongst payers and providers. UnitedHealthcare cited an additional HIE advantage from its real-time system – better follow up care which resulted in lower readmission rates and fewer ER visits. Dr. Sam Ho, the executive Vice President and Chief Medical Officer at UnitedHealthcare, noted that HIEs will be critical for ER and Inpatient services because, “that is where the most discretionary utilization occurs, and that’s where the most impact can be achieved in terms of developing more affordable services and healthcare.”
In a previous post a colleague of mine identified 9 key drivers to enterprise HIE . Of these drivers there are 3 that benefit everyone involved:
Ensuring appropriate care is given at the correct time: Enterprise HIEs are driven by the clinical goal of ensuring that the appropriate level of care is provided to patients in a timely manner.
Promoting preventive medicine: Preventive medical services traditionally occur within a conglomerate of divergent clinical care settings. An appropriate Enterprise HIE solution must drive disease-management programs to promote preventive medicine services and reduce the costs associated with these critical health care services overall.
A self-sustaining business model: An Enterprise HIE must be born from a strong business model that is self-sustaining and not overtly dependent on grant funding alone in order to be successful. With the advent of healthcare reform, this strong business model will provide an efficient foundation upon which many more citizens can be incorporated into the existing ecosystem as will be required.
Together these three objectives explain how the industry will do more with less. HIEs are electronic powerhouses that move and connect information from disparate systems to different parties to promote quality through connected and informed care. In return organizations are better able to decrease excessive and unnecessary costs such as unnecessary ER visits and other healthcare misuses through analyses on data sets which identify operational weaknesses and high-risk patients within the system. Success stories, like that of UnitedHealthcare, reiterate the importance of HIEs within the industry.
